Effectiveness of Prophylactic Intranasal Phenylephrine in Prevention of Nasal Congestion and Hypotension after Spinal Anaesthesia in Obstetric Patients: A Randomised Double Blinded Study

Introduction: Spinal anaesthesia is an accepted technique in obstetric surgery but often associated with hypotension and nasal congestion. Phenylephrine, alpha 1 agonist has been tried earlier in managing such adverse situations by parenteral route. Aim: To compare the effect of prophylactic phenylephrine nasal drop versus normal saline as nasal drop in the prevention of hypotension and nasal congestion during spinal anaesthesia in emergency Lower Uterine Caesarean Section (LUCS). Materials and Methods: A prospective randomised double blinded study was conducted on 90 parturient over a period of five months. Patients were randomised into Group A (n=46) phenylephrine (3 mu g/kg) nasal drop (10%) and Group B (n=44) received normal saline nasal drop apart from all other standard pre-anaesthetic medications. Blood pressure was measured and nasal congestion recorded every two minutes in the first five minutes and then every five minutes until 30 minutes after spinal anaesthesia. Numerical variables were analysed using independent student's t-test. Results: The incidence of hypotension was significantly prevented for those participants with prophylactic phenylephrine (p<0.001) compared to the normal saline group. Systolic and diastolic blood pressures parameters after administration of spinal anaesthesia were maintained well in the phenylephrine group as compared to the normal saline group at various time intervals. Moreover, there were no incidences of nasal congestion among the parturient in the phenylephrine arm. Conclusion: Prophylactic phenylephrine nasal drop remarkably reduced the incidence of spinal anaesthesia induced hypotension and nasal congestion compared to normal saline treated group. Such approach can be recommended in emergency LUCS provided more robust data are generated from large multicentric studies.